Biomedical subjects
Publications and source records attributed to D A Driggers.
The maximal exercise stress test continues to be an important diagnostic and prognostic tool in the primary care office setting. But are you getting the most accurate information possible? Drs Driggers and Marchant discuss several factors that are crucial to the test's validity--and thus to its usefulness in your clinical practice.
Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Neonates are susceptible to infection since several elements of the immune system are deficient. At present, the most common pathogens are Group B streptococci and Escherichia coli. Prolonged rupture of membranes with amnionitis is a high-risk setting. Clinical signs suggesting neonatal sepsis include respiratory distress, poor feeding, hypothermia, seizures and hypotonia. After the sepsis work-up is completed, the initial choice of antibiotics is based on the prevailing organisms and antibiotic sensitivities within the community.
The controlled study presented demonstrates the results obtained when using the maximum exercise stress test (MEST) as a behavior-modification tool for coronary artery disease risk factors. Changes in attitudes, behaviors, and objective measurements of health were assessed in a low-risk population. Only exercise level was significantly altered (P less than .03). Changes in the other measured parameters were insignificant. The MEST test is also expensive, and no benefit has been demonstrated in terms of its ability to decrease the morbidity and mortality seen in coronary artery disease.
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Passive immunization is available against rabies, varicella, tetanus and hepatitis A and B. Active immunization is, in general, more efficacious with live attenuated viruses than with many of the bacterial vaccines. Toxoids, too, are very effective immunizing agents. Immunization usually starts at two months of age with DTP and oral poliovirus vaccine. For patients at high risk for secondary complications, influenza and pneumococcal immunizations are advisable. Hepatitis B vaccine is now available for persons at high risk because of their occupations.
Two distinct subpopulations in the pediatric age-group are particularly at risk for poisoning, and the substances likely to be ingested by each group differ. The method of critical care given here incorporates consideration of specific types of poisoning into an overall plan of general diagnostic and therapeutic measures.
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Hypotonic fluid losses lead to hypertonic dehydration. Because the extracellular fluid compartment has the ability to draw fluid from the intracellular compartment, intravascular volume is better maintained in hypertonic dehydration than in isotonic or hypotonic dehydration. When the amount of weight loss is known, the fluid deficit can be easily calculated; otherwise, a clinical assessment of the percentage of dehydration is required.
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This study was designed to compare the effectiveness of laboratory tests for iron deficiency (mean corpuscular volume, erythrocyte protoporphyrin, transferrin saturation, and serum ferritin) in predicting hemoglobin response to iron therapy in infants found to have low Hgb concentrations. Screening for anemia was performed on capillary blood of 1,128 healthy 1-year-old infants of United States Air Force personnel. The 25% who had Hgb values less than 11.5 gm/dl were asked to return for tests on venous blood before therapy and again after three months of therapy. Of the 188 infants completing therapy, 66 (35%) had a rise in Hgb concentration greater than or equal to 1.0 gm/dl and were designated responders. None of the confirmatory tests on venous blood reliably distinguished responders from those who subsequently showed no response. By using any one of the tests in combination with a capillary Hgb value less than 11.5 gm/dl, more than half of the infants with an abnormal value responded. But well over half of the responders would have been missed if treatment had been restricted to infants with abnormal values. Neither changes in the criteria for normality nor combinations of tests substantially improved our ability to distinguish the two groups. Because of the difficulty in distinguishing responders from nonresponders with additional laboratory tests and because of the simplicity, low cost, and relative safety of iron therapy in infants, we favor an initial therapeutic trial of iron first for determining the cause of low Hgb values in similar high-risk populations. Further costly workup can then be reserved for the small number of infants who still have unexplained Hgb concentrations less than 11.0 gm/dl after a therapeutic trial.
Initial screening for anemia was performed on a capillary blood sample in 800 apparently healthy one-year-old white infants. Twenty-six percent had a Hgb or MCV below the estimated tenth percentile of normal and were asked to return for blood counts on a venous sample. They were then started on a three-month course of oral iron. Of the 151 infants who satisfactorily completed the treatment regimen, 54 had a greater than or equal to 1 gm/dl rise in venous Hgb (2.8 infants treated/response). If conformation of the capillary by the venous values had been a prerequisite for treatment, the size of the treatment group would have decreased from 151 to 87, the response rate would have been improved to 2.0 infants treated per response, but 11 of the infants who had a greater than or equal to 1 gm/dl response would have been missed. Since toxicity from iron therapy is rare, either the use of capillary blood counts alone or in combination with venous values constitutes a satisfactory basis for a therapeutic trial of iron in similar populations. Further evaluation can then be reserved for the small number whose Hgb remains below the lower limit of normal after treatment.
The purpose of this study was to determine the Hgb response to a therapeutic trial of iron in infants with anemia compared to those with low-normal hemoglobin values. Hgb was determined in 1.128 one-year-old infants. The 278 infants (25%) who had an Hgb less than 11.5 gm/dl were given a three-month oral course of ferrous sulfate (3 mg iron/kg/day); the regimen was satisfactorily completed by 188 infants. Of the 75 infants whose initial capillary Hgb was in the anemic range (Hgb less than 11.0 gm/dl), 45% had an increase in venous Hgb greater than or equal to 1.0 gm/dl. Of the 113 infants with initial capillary values in the low-normal range (11.0 to 11.4 gm/dl), 28% had greater than or equal to 1.0 gm/dl Hgb response. Despite the lower rate of response in the low-normal group, almost half of the infants with a greater than or equal to 1 gm/dl response would have been missed by using the generally accepted cutoff value of 11 gm/dl for a therapeutic trial. Because of the low cost and simplicity of a therapeutic trial, we favor including the low-normal Hgb group for a therapeutic trial of iron in order to avoid missing iron-responsive individuals among groups of infants with a similarly high prevalence of iron deficiency anemia.